Minimum Safety Gear & Items in First Aid Kit

[Paul Nelson]

At the San Gabriel Rendezvous, Sonny Lawrence mentioned some near misses about people not having the right gear to resolve situations. See
http://www.canyoneering.net/forums/showthread.php?t=386&page=5&pp=10

This is especially true when the canyon becomes more complex and remote. Sonny mentioned everyone should have a whistle and prussiks. I realize every canyon is different and which necessitates different gear, but I wanted to start a discussion of what gear, and also what items should be first aid kit. Of course, if every canyoneer takes a first aid class that would be ideal.

Minimum Safety Gear
Helmet
Prussiks
Whistle
Knife or Scissors (penny snips) in easy location to get to.
Small Head Lamp (never know when you will be delayed)
Rescue Pulley (hopefully someone in group is trained on how to use it)
First Aid Kit (see more below)
Extra set of thermals (When night falls, and your wet, you must stay warm.)

Most first aid kits are fine for the scrapes and minor cuts, but are inadequate if you get a major cut or broken bone. I purchase one, then add additional items. Canyons are often remote and hard to get to and your on own for many hours. You need items either to keep going or stabilize the person until help arrives. Everyone probably does not need to carry a kit, but as the party size grows there should be additional kits carried.

First Aid Kit Items (Some of these may require first-aid training)
Band Aids
Mole Skin
Medical Tape
Duct Tape
Gauze pads
Butterfly bandages
Super Glue (can be used to glue cut shut, yes I have seen this done.)
Syringe (for cleaning deep cuts)
Antiseptic (for cleaning wounds)
Anti-bacterial ointment
Sam Splint (Probably not absolutely necessary, can use other gear, branches, etc)
Scissors
Tweezers
Tea Bags (chemical in tea helps stop bleeding. I have used this technique and it works)
Space Blanket
Pain Reliever (Most over the counter isn’t going to help if there is a severe wound, you may need prescription stuff.)
Latex Gloves (Limit risk of hepatitis, AIDS, whatever else)
Hand Sanitizer

Finally, if someone is a diabetic or severally allergic to bee stings, please let the leader or someone else in your group what to do if you have trouble or become unconscious.

Comments?

[mtngoat59102]

Mole Skin is first aid or bo-bo item? I would toss the Mole skin in a heart beat for an ace bandage I could use for a pressure dressing. SAM splints make excelent emergency C-collars ... twigs, etc can be used to stabalize limbs.

How much weight/room will you invest in anti-biotics/sterile wipes? Are you concerned that infection will kill/incapacitate you before you reach help? Would a good rinse w/syringe and clean water be enough until you reach real medical help? First Aid kits are highly subjective. I think your basic list is good, + or - a few items for personal taste.

I like what Rich C. says. He has two types of first aid kits. One is his bo-bo bag with band-aids, mole skin, headache medicine of your choice and regular ouchie type items. The other type of kit is, well, for serious injury. Every canyoneer should always have a bo-bo kit along for their own personal needs. Hopefully, someone in the party will have a more serious kit in case the fecal matter decides to hit the oscillator. It's a good idea that everyone know who's pack that more serious kit is in. The more people in your group that know how to use it the better.

I'm no expert but that is my 2 cents. Stay safe out there,

[rcwild]

I understand what you're trying to accomplish, Paul, but there are some problems with providing a gear list. Maybe better to have a skill/gear list. The more skills you have, the less gear you need to carry.

Helmet? Check!

Prussiks? Maybe better to say "ability and gear to ascend fixed ropes". Cord, sling, ascenders, figure eight, etc. can all be used to ascend, but won't do anyone any good if they don't know how to use them.

Whistle? Maybe better to say "whistle and knowledge of standard whistle signals".

Rescue pulley? I don't carry one, but I can set up a z-rig with a couple carabiners. Maybe better to say "ability and gear to rig hauling system".

Headlamp? Check.

Etc.

Similar point regarding first aid kits. Dave Black carries a prescription pain killer and duct tape. With his improvisation skills, he can do a lot more with these two items than many people can do with a complete store-bought expedition first aid kit.

Also heard the ideal first aid kit is ibuprofin and a .357. Nothing can go wrong that can't be cured with one of these.

[Paul Nelson]

I

Also heard the ideal first aid kit is ibuprofin and a .357. Nothing can go wrong that can't be cured with one of these.

I thought it was a bottle of Jack Daniels and a 45! I like to add a MPG-3 player with "I Drink Alone" by George T.

Yep, I added boo-boo stuff in addition to other more serious stuff. I agree some things could be left out, depending on the situtation. Infection is not much of a problem if your a few hours from getting help. However, if your a day or more travel from help, infection becomes an issue.

I have three first aid kits that I take depending on where I am going and for how long.

When I get more comments, I will follow-up with a revised list vs situation post.

My goal is to develop a check list that I, or others, can use to bring the right gear on a short, med, or long canyon or hike or cave or travel trip.

Paul

[janefontana]

For those who travel as a couple, separate your individual gear! Mark had my whistle, fleece, first aid kit, and waterproof matches (another essential, I think), and I had his beanie (important!) and a few other things -- then we ended up on opposite sides of the threatened emergency.

Thanks to the strength of Mark, John, and Bernt, the knowledge and agility of Sonny, and the luck of the rap order (I wouldn't have brought the rope down far enough), we all ended up fine and better for the experience.

[Zarka]

In addition to the basic:
1 whistle = coming up or stop
2 = safe to come down
3 = emergency

I think 3 is too ambiguous to have been much help yesterday, though it worked in part. What about
4=rope too short (how this is remedied depends on situation)
5=pull the rope up and inspect


One suggestion yesterday which would have been a good one, is if the people on top couldn't figure it out, they considered sending down a nalgene bottle with pen and paper inside. As long as they had lowered it far enough!
:eek:

I think pen and paper are good items to have.
What if the beauty of Fox Creek induces a Haiku emergency?
;)

[mrklusman]

A note of caution on the use of prescription-strength (particulary narcotic) painkillers. Use of highly potent painkillers to treat acute pain after injury can lead to severe and potentially life-threatening side effects. Respiratory depression, increased inter-cranial pressure, drug interaction issues, nature of injury, mental status, etc. all need to be considered.

Managing dosages, understanding contraindications, monitoring expiration dates, storing the med in a controlled "environment" (vs. 9 months in a pack that has baked in the sun or the back of your truck), etc. are all issues that must be understood - particularly if you are going to provide the drug to someone else for their pain.....

NSAIDs, antihistamines, etc. are useful in a personal or group FA kit, but carrying and using strong pain meds needs to be carefully considered. Pain can be debilitating but it won't kill you. An overdose on a painkiller might.

I tend to agree w/Rich - a deep skill base and the ability to improvise when necessary can reduce gear-intensity. Take a wilderness first aid course as part of your personal skills development.

Just my $.02

[rcwild]

A note of caution on the use of prescription-strength (particulary narcotic) painkillers. ...

If this is in reference to my post about Dave Black carrying prescription pain killer and duct tape, I was remiss for not mentioning that Dave is a trained paramedic with years of experience as a military medic, mountain expedition medic, etc. I did not mean to suggest anyone else should carry prescription pain killers.

I do not have Dave's medical expertise, so I carry ibuprofin.

[mrklusman]

If this is in reference to my post about Dave Black carrying prescription pain killer and duct tape, I was remiss for not mentioning that Dave is a trained paramedic with years of experience as a military medic, mountain expedition medic, etc. I did not mean to suggest anyone else should carry prescription pain killers.

I do not have Dave's medical expertise, so I carry ibuprofin.

Rich - This was actually in reference to the original post from Paul about, "Pain Reliever (Most over the counter isn’t going to help if there is a severe wound, you may need prescription stuff."

Serious injury and strong painkillers can be a lethal combination if used inappropriately.

Many MDs will write scrip for someone who is their patient that they know participates in activities such as canyoneerng or mountaineering that may take them to remote (i.e., extended evac.) locations. The big problem comes when someone else is injured and, in an effort to alleviate someone's discomfort, they break out the Tylenol+codeine.....

When applied correctly, by knowledgable personnel like Dave, narcotic painkillers can work wonders and make a difficult or extended evacuation much more tolerable. In 10+ years of mountain rescue work I have seen only a few instances where powerful painkillers were appropriate.

I agree that ibuprofin is probably the best option for most people.

[mtngoat59102]

The big problem comes when someone else is injured and, in an effort to alleviate someone's discomfort, they break out the Tylenol+codeine.....

Is the lesson here about giving meds to somebody else? I carry scrip pain killer for myself in my FA kit. Sounds like people need to think long and hard before giving them to others. Am I missing something?

[mrklusman]

Is the lesson here about giving meds to somebody else? I carry scrip pain killer for myself in my FA kit. Sounds like people need to think long and hard before giving them to others. Am I missing something?

The point is really around the use of these meds for yourself or others and the fact that it requires a level of understanding about possible issues that most of us just don't posses and, in an emergency situation, may not remember. The thinking long and hard part is key. Particularly when giving the meds to someone for whom the scrip was not written.

I'm not suggesting that prescription painkillers shouldn't be used, but that they are a very powerful tool that can be very unforgiving if used improperly.

[dccampen]

Is the lesson here about giving meds to somebody else? I carry scrip pain killer for myself in my FA kit.
In a cave rescue class I attended this scenario came up in one of the mock rescues. The patient had a possible simple fractue and had his own prescription pain meds that he wanted to take but the rescuers had discouraged this. In the post-mock review a physician/instructor stated that the patient should not have been discouraged from taking his own narcotic pain meds if that was what he wanted to do. This rescue was an assisted self rescue and the physician/instructor felt that prescription pain meds would have been usefull.

[mrklusman]

In a cave rescue class I attended this scenario came up in one of the mock rescues. The patient had a possible simple fractue and had his own prescription pain meds that he wanted to take but the rescuers had discouraged this. In the post-mock review a physician/instructor stated that the patient should not have been discouraged from taking his own narcotic pain meds if that was what he wanted to do. This rescue was an assisted self rescue and the physician/instructor felt that prescription pain meds would have been usefull.

In the case cited above I would tend to agree w/the instructor. The meds are for the subject, prescribed, I assume, by the subjects MD who knows his history, the nature of the injury is clear, etc. Given the scenario - giving the meds is probably a good decision, but what if the fracture is a distracting injury and the subject has a suspected closed head injury? Or the subject is taking an antihistamine for a cold? Or became pregnant since the prescription was written? The decision would likely be very different.

I guess my whole point re: prescription painkillers is that the average joe canyoneer should be very careful about their use when treating post-injury pain. Are they useful? Absolutely. Knowing when it's appropriate and when it is not is something you need to understand before you go down that path.

[Paul Nelson]

In the case cited above I would tend to agree w/the instructor. The meds are for the subject, prescribed, I assume, by the subjects MD who knows his history, the nature of the injury is clear, etc. Given the scenario - giving the meds is probably a good decision, but what if the fracture is a distracting injury and the subject has a suspected closed head injury? Or the subject is taking an antihistamine for a cold? Or became pregnant since the prescription was written? The decision would likely be very different.

I guess my whole point re: prescription painkillers is that the average joe canyoneer should be very careful about their use when treating post-injury pain. Are they useful? Absolutely. Knowing when it's appropriate and when it is not is something you need to understand before you go down that path.
When I mentioned the possible use of prescription medications, I made the assumption that they would be used by the person having the prescription and not handed out to anyone that might want them. I agree with your concerns about the use of prescription medications.

You implied contradictions between antihistamine and pain medication. As a person that takes antihistamines for allergies, what is the contradiction you are concerned about? I am going to have to do some more research on this topic.

I am going to let this topic sit for awhile to get more comments. My tentative plan is the follow-up with a first-aid item list for 3 types of trips: (1) Single day and easy access. (2) Weekend trip or difficult access (3) Extended or very difficult access. What I mean by access, is if you’re a full day’s hike, then a half-day drive to contact emergency services, then the more training and/or gear you need to have.

[mrklusman]

.....You implied contradictions between antihistamine and pain medication. As a person that takes antihistamines for allergies, what is the contradiction you are concerned about? I am going to have to do some more research on this topic....

I guess I opened a whole can of worms on re: prescription painkillers, but people are really thinking and that is a good thing.

Powerful analgesics (like codeine) have a strong sedative effect. Example - If you are taking other meds w/strong sedative effects (like an antihistamine) you MAY inadvertently impact critical body functions such as respiration.

A physician or other medical professional (e.g., paramedic) will ask about other meds you may be taking and alter their course of treatment accordingly. We always want to find out if you have other medical conditions and what/if you take something for that condition.

Talk to your doc for specifics re: drug interactions and your presonal meds.

This is a great topic and something we all need to wrestle with. How much is enough? What is too much? What level of training is possessed by individuals in the group?

[ratagonia]

I guess I opened a whole can of worms on re: prescription painkillers, but people are really thinking and that is a good thing.

Powerful analgesics (like codeine) have a strong sedative effect. Example - If you are taking other meds w/strong sedative effects (like an antihistamine) you MAY inadvertently impact critical body functions such as respiration.

A physician or other medical professional (e.g., paramedic) will ask about other meds you may be taking and alter their course of treatment accordingly. We always want to find out if you have other medical conditions and what/if you take something for that condition.

Talk to your doc for specifics re: drug interactions and your presonal meds.

This is a great topic and something we all need to wrestle with. How much is enough? What is too much? What level of training is possessed by individuals in the group?

And there's more. In addition to interaction with common over-the-counter meds, I know my Percocets (Codeine) are also not to be used anytime there is any compromise of respiration or and possibility of a brain injury. Hit the head? Asthmatic? Allergies? Concussion? High altitude? PneumoThorax? Flail Chest? Punctured Lung? How about a displaced collarbone break that might go down and nick the lung, resulting in a Hemo-thorax?

Better to just have nothing go wrong. Strong Meds useful in some situations, good to know when useful, and when not.

Tom

[mrklusman]

I am going to let this topic sit for awhile to get more comments. My tentative plan is the follow-up with a first-aid item list for 3 types of trips: (1) Single day and easy access. (2) Weekend trip or difficult access (3) Extended or very difficult access. What I mean by access, is if you’re a full day’s hike, then a half-day drive to contact emergency services, then the more training and/or gear you need to have.

Paul - this is a good thread with some thoughtful comments.

One thing about #2 or #3. The reality is that most severe (life threatening) injuries in these instances are not going to be survivable. Do not plan on building kits that are designed around providing advanced trauma life support.

[Paul Nelson]

Paul - this is a good thread with some thoughtful comments.

One thing about #2 or #3. The reality is that most severe (life threatening) injuries in these instances are not going to be survivable. Do not plan on building kits that are designed around providing advanced trauma life support.
Are you saying the portable defibrillator is too much to carry? :rolleyes: hee hee

Trauma life support equipment is beyond first aid. It was mentioned a roll off duct tape and creativity is all one may need. That may be true on an easy day trip. What about a deep cut and over a day away from medical treatment. Infection is now an issue to deal with.

The person who had a deep cut on the Great Falls of the Fox trip was fortunately patched up by someone with skill and the right supplies. She was able to finish the trip without any problems. What if this type of injury occurs and you are in a very remote place? What do you need?

[catware11]

The person who had a deep cut on the Great Falls of the Fox trip was fortunately patched up by someone with skill and the right supplies. She was able to finish the trip without any problems. Denise used a betadine wash on my cut with a syringe she had. Then Steri-strips to hold it together (and some bandages on top).

I don't remember them doing anything in the ER other than taking off the bandaging, washing out the cut with saline, injecting lidocaine w/ epinephrine for pain control, stitching it up, and then giving me a Keflex (antibiotic) Rx (1 QID x 10d). No other infection control. It's healing fine (although the scar is going to be more noticeable than I hoped :( )